452 Obstetrics and Gynecology Board Review •••
❍ How are endometrial stromal nodules treated?
Hysterectomy is recommended. However, successful treatment using myomectomy has been reported.
❍ Worm-like extension of tumor into lymphatic and vascular channels, occasionally with extensive
extrauterine extension, is seen in which type of sarcoma?
ESS, formerly known as endolymphatic stromal myosis. At operation, this may resemble intravenous
leiomyomatosis or a broad ligament leiomyoma, but frozen section analysis can usually make the distinction.
❍ Why is removal of the ovaries recommended for patients undergoing surgery for a endometrial stromal
sarcoma?
These tumors often have high levels of estrogen and progesterone receptors, and their growth may be stimulated by
estrogen. High-dose progesterone has been demonstrated to be therapeutically active.
❍ What percentage of stage I ESS cases recur?
Approximately 50% recur at a median of 3 years following diagnosis.
❍ What is the most common uterine tumor in reproductive-aged women?
Benign leiomyomata.
❍ What is the incidence of discovering a leiomyosarcoma following surgery for presumed benign
leiomyomata?
Approximately 0.2% to 0.3%.
❍ How does the origin of leiomyosarcomas differ from that of other uterine sarcomas?
Leiomyosarcomas originate in the myometrium; all others originate in the endometrium.
❍ What histologic criteria are used to classify a leiomyosarcoma?
Hypercellularity, moderate to severe nuclear atypia, mitotic index >15 mitoses total per 10 high-power field, and
coagulative tumor cell necrosis.
❍ What is the average age for patients with leiomyosarcomas?
53 years of age.
❍ What are the most frequent presenting symptoms for patients with leiomyosarcomas?
Abnormal uterine bleeding, which occurs in over three quarters of patients. Pelvic pain and rapid uterine
enlargement can be other presenting symptoms.
❍ How reliable is the preoperative diagnosis of a rapidly enlarging uterus in predicting the presence of a
leiomyosarcoma?
A recent study found only one leiomyosarcoma among 371 patients undergoing hysterectomy for a rapidly
enlarging uterus.
❍ A preoperative diagnosis of leiomyosarcoma is made in what percentage of cases?
15%, despite up to one-third of the tumors being submucous.